Further Readings

Harms of Excessive Alcohol Consumption

• Alcohol-related harm is expressed as a continuum; no level of alcohol consumption is completely safe.⁷ Even small amounts can pose risks and cause harm. Those who consume alcohol are directly affected, but innocent bystanders can also suffer from alcohol-related violence or accidents, such as drunk driving. Additionally, social issues like workplace difficulties, family problems, and interpersonal violence have substantial costs for the entire community.⁷
• Acute effects of “excessive” alcohol intake include impaired judgment and coordination, significantly raising the risk of accidents, while higher consumption can lead to emotional changes and alcohol poisoning, potentially life-threatening. Clinical signs and symptoms of acute alcohol intoxication include mental confusion, difficulty to remain conscious, vomiting, seizures, slow breathing, irregular breathing, and slow heart rate.⁸
• Chronic heavy drinking is associated with serious health issues. According to the WHO Global status report, in 2019, 2.6 million deaths were attributable to alcohol consumption due to detrimental causes such as digestive diseases, cardiovascular diseases, cancer, and unintentional injuries.⁹ Binge drinking also negatively affects mental health and social relationships.
• Alcohol has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer of the World Health Organization, as the consumption of alcoholic beverages has been linked to cancers of oral cavity, pharynx (excluding nasopharynx), larynx, oesophagus, liver, colorectum, and female breasts in humans.¹⁰
• Specifically for women, alcohol consumption impacts fertility, and during pregnancy poses severe risks to both the mothers and the fetus. Fetal alcohol spectrum disorders (FASDs) refers to the range of physical and neurobehavioral conditions due to prenatal alcohol exposure, including fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects.¹¹ Complications also includes miscarriage, stillbirth, preterm delivery¹² and an ongoing series of developmental disorders after birth.¹¹
• Exposure of infants to alcohol via breast milk has been associated with delayed cognitive development, increased infant agitation, and disrupted sleep patterns.^13-15

Interventions to Reduce Harmful Drinking

• The Alcohol Use Disorders Identification Test (AUDIT) was considered the best screening instrument for the whole range of alcohol problems in primary care, as it provides an accurate measure of risk of hazardous and harmful alcohol use, as well as possible dependence across gender, age and cultures.²
• Screening, brief intervention, and referral to treatment (SBIRT) programmes have been consistently reported to be effective in both primary care and emergency department settings.¹ Brief interventions in primary care could reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention (mean difference: -20 grams/week, 95% CI: -28 to -12), regardless of socioeconomic status.⁵
• It was estimated that the lifetime quality-adjusted life-year (QALY) gained from screening plus brief intervention was likely to be in the region of 4-19 per 1000 compared to no intervention.¹⁶